Active NPI
Jerome C Berndt, LICSW & LMFT
- Marriage & Family Therapist
- Grand Rapids, MN
National Provider Identifier
1770705337
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 36
- Practice address
- 215 SE 2ND Ave
Grand Rapids, MN 55744-3615 - Phone
- (218) 326-1274
- Fax
- (218) 326-8255
- NPI assigned
- May 3, 2007
- Last updated
- May 20, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 00563 | MN | |
| Marriage & Family Therapist | 106H00000X | 36 | MN | Primary |
Addresses
Primary practice location
215 SE 2ND Ave
Grand Rapids, MN 55744-3615
Mailing address
215 SE 2ND Ave
Grand Rapids, MN 55744-3615
Phone (218) 326-1274
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 62-20162 | Other | MN | UNITED BEHAVIORAL HEALTH |
| 69264BE | Other | MN | BCBS OF MINNESOTA |
| 1009418 | Other | MN | PREFERRED ONE |
| 70235700 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00563 | MN | MD | Social Worker |
| 36 | MN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211241600000",
"number": "1770705337",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "215 SE 2ND AVE",
"city": "GRAND RAPIDS",
"state": "MN",
"postal_code": "557443615",
"telephone_number": "218-326-1274",
"fax_number": "218-326-8255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "215 SE 2ND AVE",
"city": "GRAND RAPIDS",
"state": "MN",
"postal_code": "557443615",
"telephone_number": "218-326-1274",
"fax_number": "218-326-8255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERNDT",
"first_name": "JEROME",
"middle_name": "C",
"credential": "LICSW & LMFT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-03",
"last_updated": "2008-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "MN",
"license": "00563",
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "MN",
"license": "36",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH",
"identifier": "62-20162",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MINNESOTA",
"identifier": "69264BE",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "1009418",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "70235700",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.